Provider Demographics
NPI:1871632919
Name:HAUER, ALLEN LEE (PH D)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:LEE
Last Name:HAUER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4774
Mailing Address - Country:US
Mailing Address - Phone:920-231-8869
Mailing Address - Fax:920-231-8910
Practice Address - Street 1:303 PEARL AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4774
Practice Address - Country:US
Practice Address - Phone:920-231-8869
Practice Address - Fax:920-231-8910
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0616103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84349Medicare ID - Type UnspecifiedPSYCHOLOGIST